Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 25-year-old woman suffered from hyperemesis gravidarum when she was seven weeks pregnant. Since her vomiting continued, she received intravenous dextrose and electrolytes without thiamine in a hospital. One month later, she developed gait disturbance, followed by confusion and dysarthria. On admission to our department, she was confusional and had ataxic dysarthria. Spontaneous and gaze evoked nystagmus was present. Limb coordination was bilaterally ataxic. Based on her clinical course and symptoms, she was diagnosed as having Wernicke's encephalopathy. From the admission day, intravenous infusion of vitamin B1 (600 mg/day) was started. A few days later, her consciousness and limb ataxia began to improve. However, truncal ataxia and polyneuropathy became evident. Eight weeks after onset, she developed Korsakoff's psychosis such as anterograde and retrograde amnesia, disorientation and confabulation. We administered large amounts of corticosteroid (methylprednisolone 500 mg/day) in order to reduce brain edema or stabilize the impaired blood-brain barrier. Soon after, her psychosis began to improve gradually. She recovered remarkably from the psychosis, but she was left with persistent nystagmus, mild ataxic gait and polyneuropathy. The present case suggests that corticosteroid may have the beneficial effect on Wernicke-Korsakoff syndrome.
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PMID:[Beneficial effect of steroid pulse therapy on Wernicke-Korsakoff syndrome due to hyperemesis gravidarum]. 795 22

Outcome in terms of progression of Korsakoff's psychosis is known to be unlikely when the preceding thiamin deficiency syndrome, Wernicke's encephalopathy, does not follow heavy alcohol use. There is evidence that alcohol potentiates thiamin-related brain damage. It is argued here that in heavy drinkers, if vomiting precedes the onset of the encephalopathy, then the latter might develop at a time when tissue alcohol levels are close to zero. Any progression to Korsakoff's psychosis could then be associated with less or even no impairment. This outcome would not be expected if ingestion of alcohol continued during the vomiting stage. In a follow-up study of 61 cases of alcoholic Wernicke's encephalopathy, these concepts are given some support by the results obtained.
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PMID:A feature of alcoholic Wernicke's encephalopathy favourable to the maintenance of memory function: vomiting. 835 45

The Wernicke-Korsakoff syndrome (WKS) is a picture of oculomotor alterations, ataxia and confusion presented in chronic alcoholics. It has more rarely been described in non alcoholic patients with malnutrition. The case of a patient with ulcerous peptic disease of long evolution who consulted for a picture compatible with WKS following clinical manifestations of repeated vomiting secondary to complete pyloric stenosis is presented. The peculiarity of the picture and the convenience of prevention in malnourished patients receiving intravenous glucose sera is discussed.
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PMID:[Pyloric stenosis complicated by Wernicke-Korsakoff syndrome]. 916 33

Gastric reduction operations are designed to control body weight by establishing a small, meal-size juxtaesophageal, gastric pouch that empties into the jejunum (gastric bypass) or the larger portion of the stomach (gastroplasty). If the outlet of the pouch is too small, a patient may be limited to ingesting clear liquids. Vomiting then occurs if heavier liquids or normal foods are taken. An occasional patient has difficulty eating properly and vomits even though the pouch volume and outlet are of optimum size. For a patient who reports vomiting, a distinction must be made between episodic improper eating and uncontrolled starvation. Three types of starvation injury are described: (1) sudden death from protein malnutrition; (2) refeeding syndrome; and (3) Wernicke-Korsakoff syndrome. The mechanisms of the development, manifestations, prevention, and treatment of these complications are explained. Surgeons who treat severe obesity should be aware of these complications and be prepared to manage patients who have uncontrolled vomiting so that such complications either do not develop or are recognized and treated as early as possible before serious and irreversible injury occurs.
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PMID:Starvation injury after gastric reduction for obesity. 971 29

Hyperemesis gravidarum can induce Wernicke-Korsakoff syndrome (WKS), a thiamin deficiency disorder characterized by ocular abnormalities, ataxia and disturbance of consciousness. This should be considered in the differential diagnosis of pregnant patients with persisting vomiting and neurological alterations.
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PMID:Memory loss and ataxia after hyperemesis gravidarum: a case of Wernicke-Korsakoff syndrome. 1203 1

Beri-Beri is caused by vitamin B1 (thiamine) deficiency. Thiamine is essential for carbohydrate metabolism and the generation of energy. Depending on age and calorie intake, 1-1.5mg/day are required with a 50% increase during pregnancy and lactation. Fever and increased muscular activity will also increase thiamine requirements (storage in muscles is limited, and reserves are quickly depleted). The sources of thiamine are meat, the outer layer of cereal grains and pulses, nuts, and leafy vegetables. The vitamin is lost during milling and processing and during excessive cooking. Beri-beri takes 2 forms: wet beri-beri which has a high output biventricular failure with edema associated with profound peripheral vasodilation and tachycardia (this also occurs in an acute fulminating form known as shoshin beri-beri) and dry beri-beri with symptoms of peripheral neuropathy with taxia, weakness, paraesthesia, and patchy sensory loss with areflexia. In this form, foot and/or wrist drop may occur. Thiamine deficiency can also produce Wernicke-Korsakoff psychosis characterized by vomiting, horizontal nystagmus, ophthalmoplegia, memory loss, and confabulation. Wet beri-beri is a medical emergency treated by intravenous administration of thiamine for several days. 38 patients (27 men and 11 women) were identified with beri-beri in urban Banjul in the Gambia. 14 had wet beri-beri, 11 a mixed presentation, and 13 dry beri-beri. Most of the patients were disabled for many months. Risk factors were pregnancy, alcohol consumption, fever, exercise, diabetes, and dysentery. 4 of the patients died (2 were in the last trimester of pregnancy). The staple diet in urban areas of the Gambia is imported, polished white rice in a groundnut- or oil-based sauce with fish and vegetables such as peppers, onions, and tomatoes. Meat is too expensive for the urban poor, and fruit and vegetable consumption is highly seasonal and income-dependent. There is little chance that this diet will be changed for the 46% of the population who live in urban areas. It is likely that a substantial proportion of the population has subclinical thiamine deficiency and are at risk of beri-beri. Since thiamine added to imported rice will be destroyed by traditional means of cooking, adding the vitamin to wheat flour may be an appropriate public health measure.
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PMID:Beri-beri: "Endemic amongst urban Gambians". 1231 72

Wernicke-Korsakoff syndrome (WKS) and disordered eating behavior have been reported separately after bariatric surgery. We report a patient who following a bariatric operation developed WKS associated with a disturbed eating behavior without vomiting. This morbidly obese man developed an intense fear of gaining weight in the postoperative period and engaged in an extreme form of "food avoidance behavior". 2 months postoperatively after severe weight loss, he was hospitalized with disorientation and an amnesic syndrome. He was discharged 2 months later with stable weight and regular eating habits. Despite this, at the last follow-up visit 2 years postoperatively, he still had a residual partial amnesic syndrome. The surgical team must be aware of peculiar forms of pathological eating that may appear after bariatric surgery; the emergence of an eating avoidance disorder may be associated with the development of WKS.
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PMID:Eating avoidance disorder and Wernicke-Korsakoff syndrome following gastric bypass: an under-diagnosed association. 1619 98

We report a clinical and neuroradiological description of a severe case of Wernicke's encephalopathy in a surgical patient. After colonic surgery for neoplasm, he was treated for a long time with high glucose concentration total parenteral nutrition. In the early post-operative period, the patient showed severe encephalopathy with ataxia, ophthalmoplegia and consciousness disorders. We used magnetic resonance imaging (MRI) to confirm the clinical suspicion of Wernicke's encephalopathy. The radiological feature showed hyperintense lesions which were symmetrically distributed along the bulbo-pontine tegmentum, the tectum of the mid-brain, the periacqueductal grey substance, the hypothalamus and the medial periventricular parts of the thalamus. This progressed to typical Wernicke-Korsakoff syndrome with ataxia and memory and cognitive defects. Thiamine deficiency is a re-emerging problem in non-alcoholic patients and it may develop in surgical patients with risk factors such as malnutrition, prolonged vomiting and long-term high glucose concentration parenteral nutrition.
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PMID:Wernicke's encephalopathy in a malnourished surgical patient: clinical features and magnetic resonance imaging. 1622 8

Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.
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PMID:[Wernicke encephalopathy after subtotal gastrectomy for morbid obesity]. 1855 79

A 71-year-old woman with myelofibrosis on chemotherapy experienced an acute illness with nausea, vomiting, and diarrhea. Two weeks later, she developed an acute confusional state characterized by disorientation and fluctuating alertness with normal speech and language. Her neurologic examination demonstrated an upper motor neuron pattern of right hemiparesis. She reported double vision though ophthalmoparesis was not appreciated. Her gait was normal. While hospitalized, she developed generalized tonic-clonic seizures. Brain MRI revealed a small area of restricted diffusion of the left precentral gyrus (figure). She was diagnosed with a stroke with secondary seizures; however, as the confusional state resolved, she developed profound retrograde and anterograde amnesia. Review of the brain MRI showed high T2 signal in the medial thalamus and contrast enhancement of the mamillary bodies; a diagnosis of Wernicke-Korsakoff syndrome was entertained and she was started on thiamine replacement. The encephalopathy and hemiparesis resolved though she remains severely amnestic.
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PMID:Brain MRI findings in Wernicke encephalopathy. 2419 23


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